Obamacare will fail if he doesn’t start paying more attention to the details of implementation, if he doesn’t start demanding action. And, in a larger sense, the notion of activist government will be in peril — despite the demographics flowing the Democrats’ way — if institutions like the VA and Obamacare don’t deliver the goods. Sooner or later, the Republican Party may come to understand that its best argument isn’t about tearing down the government we have, but making it run more efficiently.

Yuval Levin? Gov. Scott Walker? Nope, that’s uber-liberal columnist Joe Klein, who has — to his credit — discovered and is willing to admit to the serious absence of administrative competence and effort endemic in this administration.

It is much more than just Obamacare, as we have witnessed the president bounce like a ping-pong ball in a wind tunnel from crisis to crisis. Sequestration. North Korean saber-rattling. Failure of his anti-gun agenda. There is not an initiative he’s begun either foreign or domestic that has been well conceived, introduced and implemented. Add in Fast and Furious and the series of green-energy crony capitalism flops and you have an extraordinary record of ineptitude. (Klein supplies examples of less-discussed failures: “There has also been the studied inattention to the myriad ineffective job-training programs scattered through the bureaucracy. There have been the oblique and belated efforts to reform Head Start, a $7 billion program that a study conducted by its own — the Department of Health and Human Services — has found nearly worthless. The list is endless.”)

"There has also been the studied inattention to the myriad ineffective job-training programs scattered through the bureaucracy. There have been the oblique and belated efforts to reform Head Start, a $7 billion program that a study conducted by its own — the Department of Health and Human Services — has found nearly worthless. ""

As even liberals like Klein have noticed, Obama's promises to "reform" government have been a joke. He is only interested in expanding government.

He is clearly captive to the federal bureaucracy...as the leader of the "Party of Government" , he only cares about expanding government's reach, not efficiency or bureacracy's effect on real people.

the far left doesn't support obama at all. obama isn't far left, he is right of center. you have no clue what you're talking about. the only people who support obama are the ignorant, naive, and uninformed who don't also happen to be racist.

oh ok but, that's an opinion based on your perception of left, far left, center, and right of center which are all ambiguous points of reference.

It was a huge mistake not to go for the public option. Now that we have direction from the Supreme Court on how to properly legislate it, it will be a huge mistake for Democrats not to push for single-payer immediately after they take back the House in 2014.

Let the insurers go the way of the dodo. We don't need them. We already know the government performs better when it comes to controlling costs. Everyone needs healthcare. Let's get it from those who know how to run it. Doctors can make a better living. Drug prices can be controlled. Equipment prices can be controlled. Hospital costs can be controlled. And businesses can be freed of the burden of paying for employee health plans and do what they do best.

the far left doesn't support obama at all. obama isn't far left, he is right of center. you have no clue what you're talking about. the only people who support obama are the ignorant, naive, and uninformed who don't also happen to be racist.

oh ok but, that's an opinion based on your perception of left, far left, center, and right of center which are all ambiguous points of reference.

ok ok so why include "far left" in your thread title?

It was "far far left" ;-)

It's simply to indicate that some of the left has seen and acknowleged the admins failures.

It was a huge mistake not to go for the public option. Now that we have direction from the Supreme Court on how to properly legislate it, it will be a huge mistake for Democrats not to push for single-payer immediately after they take back the House in 2014.

Let the insurers go the way of the dodo. We don't need them. We already know the government performs better when it comes to controlling costs. Everyone needs healthcare. Let's get it from those who know how to run it. Doctors can make a better living. Drug prices can be controlled. Equipment prices can be controlled. Hospital costs can be controlled. And businesses can be freed of the burden of paying for employee health plans and do what they do best.

We already know the government performs better when it comes to controlling costs

Has to be the most comical statement ever posted on BDC...ever.

Everyone needs healthcare. Let's get it from those who know how to run it.

Sorry....THIS is the most comical statement ever posted on BDC. Wow...two in one post...that's gotta be a record.

So, the govt knows how to run heath care do they? SS is in trouble, Medicare/Medicaid in trouble, CIA intelligence faulty, USPS losing billions, 5 years until full employment in US, and yet you trust govt to run our health care. Wow!

It was a huge mistake not to go for the public option. Now that we have direction from the Supreme Court on how to properly legislate it, it will be a huge mistake for Democrats not to push for single-payer immediately after they take back the House in 2014.

Let the insurers go the way of the dodo. We don't need them. We already know the government performs better when it comes to controlling costs. Everyone needs healthcare. Let's get it from those who know how to run it. Doctors can make a better living. Drug prices can be controlled. Equipment prices can be controlled. Hospital costs can be controlled. And businesses can be freed of the burden of paying for employee health plans and do what they do best.

We already know the government performs better when it comes to controlling costs

Has to be the most comical statement ever posted on BDC...ever.

Everyone needs healthcare. Let's get it from those who know how to run it.

Sorry....THIS is the most comical statement ever posted on BDC. Wow...two in one post...that's gotta be a record.

So, the govt knows how to run heath care do they? SS is in trouble, Medicare/Medicaid in trouble, CIA intelligence faulty, USPS losing billions, 5 years until full employment in US, and yet you trust govt to run our health care. Wow!

Medicaid Administrative Costs (ACs) are among the lowest of any health care payer in the country.

Medicaid Administrative Costs are 4 to 6% - significantly less than an HMO with AC of 8 to 12 % vs. a 'well-run commercial health insurer' with AC of 15 to 20 %.

No insurer has lower administrative costs than Medicaid.

Harvard Researchers found that 31 cents of every dollar spent on health care in the United States pays administrative costs (double the rate in Canada).

The CBO estimated that the government paying for a poor person to buy private insurance on the a health exchange would cost $3,000 more per year than the cost of Medicaid.

We already know the government performs better when it comes to controlling costs

Has to be the most comical statement ever posted on BDC...ever.

Everyone needs healthcare. Let's get it from those who know how to run it.

Sorry....THIS is the most comical statement ever posted on BDC. Wow...two in one post...that's gotta be a record.

So, the govt knows how to run heath care do they? SS is in trouble, Medicare/Medicaid in trouble, CIA intelligence faulty, USPS losing billions, 5 years until full employment in US, and yet you trust govt to run our health care. Wow!

Medicaid Administrative Costs (ACs) are among the lowest of any health care payer in the country.

Medicaid Administrative Costs are 4 to 6% - significantly less than an HMO with AC of 8 to 12 % vs. a 'well-run commercial health insurer' with AC of 15 to 20 %.

No insurer has lower administrative costs than Medicaid.

Harvard Researchers found that 31 cents of every dollar spent on health care in the United States pays administrative costs (double the rate in Canada).

The CBO estimated that the government paying for a poor person to buy private insurance on the a health exchange would cost $3,000 more per year than the cost of Medicaid.

And if we rely on Medicaid/Medicare reimbursement our fine Boston area hospitals would be out of business. We lose MILLIONS on Medicaid/Medicare patients. We rely on the Big 3 insurers to help offset those losses. They build in a fee to keep the hospitals in the black.

These same big bad insurers also help hospitals with the costs for the "free care" pool. That would be those patients that are treated that we get no money from. For the Big 3 it's called the UCC charge. It's built into the base ARM (avg revenue per member).

Medicaid has how many members? Of course their admin is low. They also don't do as much as a health plan does. You're not comparing apple to apples.

Medicaid holds down costs in part by paying providers lower fees and doing little marketing.

When President Obama pushed through his health care bill, he cut more than $500 billion (over 10 years) in future Medicare spending in order to claim the bill was “paid for.” A better option would have been to aggressively target Medicare and Medicaid fraud, which could have provided the same amount of savings, and possibly more.

Barely a day goes by without a major news story highlighting some new Medicare or Medicaid scam that has bilked the government — that is, taxpayers — out of millions of dollars.

Though most of the reports involve only a few people and scamming under $10 million, that’s chump change when compared to some of the bigger busts.

For example, federal authorities announced on May 2 they had arrested 107 health care providers, including doctors and nurses, in several cities and charged them with cheating Medicare out of $452 million.

To put this in perspective, the collapse of the solar company Solyndra, which had taken $535 million in taxpayer dollars from the Obama administration, has been a recurring topic in the media and public debates. The Medicare fraud arrest mentioned above was a news story for only a day or two.

Or there was the 2010 story in which federal officials charged 94 people with $251 million in phony claims.

The problem isn’t new. Federal officials set up the Medicare Fraud Strike Force in 2007, which visited at random nearly 1,600 businesses in Miami, ground zero for Medicare fraud, that had billed Medicare for durable medical equipment. Officials found that nearly a third of the businesses, 481, didn’t even exist, yet they had billed Medicare for $237 million over the previous year, according to National Public Radio.

Indeed, scamming Medicare and Medicaid is so lucrative that the Russian and Nigerian mobs have gotten involved. And one of the New Yorkcrime families has moved to Florida because defrauding Medicare is both more lucrative and less dangerous than some of the traditional organized crime activities.

And Medicaid is just as bad, or worse. New York City has been a huge problem for Medicaid with one former official suggesting that 40 percent of NYC’s Medicaid payments are “questionable. ” The New York Times, in a multi-story expose several years ago, reported that a Brooklyn dentist had filed 991 claims in one day.

And while every state struggles with Medicaid fraud, the Office of Inspector General says the five topping the list are California, Texas, New York, Ohio and Kentucky. The good news is that states recovered $1.7 billion in fraudulent payments in 2011. The bad news is the government had to spend $208 million to do it.

Federal authorities boast of recovering $4.1 billion in 2011 from fraudulent activity, but again spent millions of dollars to recover it.

How much Medicare and Medicaid fraud is there? No one knows for sure. In 2010 the Government Accountability Office (GAO) released a report claiming to have identified $48 billion in what it termed as “improper payments.” That’s nearly 10 percent of the $500 billion in outlays for that year. However, others, including U.S. Attorney General Eric Holder, suggest that there is an estimated $60 to $90 billion in fraud in Medicare and a similar amount for Medicaid. Big money!

Ironically, ObamaCare cutting $500 billion, as I have pointed out elsewhere, was an accounting sham. However, there is so much Medicare and Medicaid fraud that Democrats could have covered much of the cost of ObamaCare without the accounting tricks, had they really gone after it.

To be fair, the Obama administration is trying. ObamaCare allows the Department of Health and Human Services (HHS) to step away from its “pay and chase” model — where Medicare and Medicaid routinely paid every bill that comes in and only goes after someone if it’s blatantly obvious that something was wrong … like 991 dental procedures in one day.

HHS is beginning to embrace what private sector health insurers have done for years: pre-claims adjudication. As HHS Secretary Kathleen Sebelius stated, “Now, we’re analyzing patterns and trends and claims data, instead of just going claim by claim,” according to MSNBC news. That is certainly a step in the right direction, but it doesn’t go far enough, nor fast enough.

There are no good numbers on how much money private sector health insurers lose in fraud, but working with a well-known health care actuary a few years ago, we estimated that private insurers lose perhaps 1 to 1.5 percent in fraud. Medicare and Medicaid may be closer to 10 to 15 percent. And one of the primary differences is that the private sector insurers embrace software and other new technologies that help them find discrepancies and fraud in health care claims.

It’s true that politicians routinely claim they are going to get the fraud and waste out of government programs, and almost never do. The difference here is that HHS’s pay and chase model has been an open invitation to fraud — and criminals gladly accepted it.

Catching the scammers after the fact is too late; most of the money is already gone. The government needs to process claims in a way that identifies questionable and improper claims before they are paid. If the Obama administration really wants to lower health care spending, Medicare and Medicaid fraud is a good place to start.

the far left doesn't support obama at all. obama isn't far left, he is right of center. you have no clue what you're talking about. the only people who support obama are the ignorant, naive, and uninformed who don't also happen to be racist.

I point out that the federal government does the best job at controlling medical costs.

You respond by saying that's the most comical statement ever made here.

I point out the facts behind gov't vs. private admin costs

You respond with....thats because the government pays less to providers.

to that I say.....no-shit, thats the point

is the point of healthcare to control costs, or, well, proved health care?

an interesting data point is the Oregon Medicaid lottery study, which shows that providing health insurance increases use, but not outcomes. Those not on Medicare we as healthy based on typical indicators as those on Medicaid.

Medicare covers costs, it just doesn't pay the large profit hospitals want.

Medicare funds the teaching internships for residents at all the major teaching hospitals in the country. Private insurers don't have that expense.

Medicare also pays into the free care pool just as private insurers do.

After a certain point there is no cost benefit for admin costs and the number of members. In fact, at a certain point it is counter productive to controlling costs. Every major insurer exceeds any minimum threshold for cost/benefits so that's a red herring.

Oh so it's because of the large profits hospitals want. I assume you have data backing that up?

I have to agree with the Washington Post's Jamelle Bouie assessment of today's GOP , " the GOP doesn't behave like a Party should - it isn't trying to govern and it doesn't have a particular agenda. It opposes Obama's presence in the White House , and will do anything - kills its own proposals , hold the economy hostage - to damage his standing with the public".